Carcinosarcoma of the breast:Facing the challenge of a rare nosologic entity

Carcinosarcoma(CS),also known as metaplastic breast carcinoma with mesenchymal differentiation,is one of the five distinct subtypes of metaplastic breast cancer.It is considered as a mixed,biphasic neoplasm consisting of a carcinomatous component combined with a malignant nonepithelial element of mesenchymal origin without an intermediate transition zone.Although cellular origin of this neoplasm remains controversial,most researchers declare that neoplastic cells derive from a cellular structure with potential biphasic differentiation.Despite recent research on the therapeutic strategies against CS neoplastic disorders,surgical resection appears the only potentially curative approach.Since CS metastasize by the lymphatic route,axillary assessment with sentinel lymph node biopsy and/or axillary lymph node dissection is always implemented.Nevertheless,the tumor also presents a hematogenous metastatic pattern including pleural,pulmonary,liver,brain and less commonly bone metastases.Thus,surgical removal of breast CS does not necessarily ensure patient’s long-term recovery.Moreover,alternative therapies,such as radio-and chemotherapy proved insufficient and 5-year survival rate is limited.Nevertheless,there is evidence that following surgery,the combination of radio and chemotherapy is associated with a better prognosis than either treatment alone.The aim of this review is to evaluate the results of surgical treatment for breast CS with special reference to the extent of its histological spread.Clinical features,histogenesis,morphological and immunochemical findings are discussed,while the role of current diagnostic and therapeutic management of this aggressive neoplasm is emphasized.

A FLEXIBLE OBJECTIVE-CONSTRAINT APPROACH AND A NEW ALGORITHM FOR CONSTRUCTING THE PARETO FRONT OF MULTIOBJECTIVE OPTIMIZATION PROBLEMS

In this article, a novel scalarization technique, called the improved objective-constraint approach, is introduced to find efficient solutions of a given multiobjective programming problem. The presented scalarized problem extends the objective-constraint problem. It is demonstrated that how adding variables to the scalarized problem, can lead to find conditions for (weakly, properly) Pareto optimal solutions. Applying the obtained necessary and sufficient conditions, two algorithms for generating the Pareto front approximation of bi-objective and three-objective programming problems are designed. These algorithms are easy to implement and can achieve an even approximation of (weakly, properly) Pareto optimal solutions. These algorithms can be generalized for optimization problems with more than three criterion functions, too. The effectiveness and capability of the algorithms are demonstrated in test problems.

Multilevel analysis of the central-peripheral-target organ pathway:contributing to recovery after peripheral nerve injury

Peripheral nerve injury is a common neurological condition that often leads to severe functional limitations and disabilities.Research on the pathogenesis of peripheral nerve injury has focused on pathological changes at individual injury sites,neglecting multilevel pathological analysis of the overall nervous system and target organs.This has led to restrictions on current therapeutic approaches.In this paper,we first summarize the potential mechanisms of peripheral nerve injury from a holistic perspective,covering the central nervous system,peripheral nervous system,and target organs.After peripheral nerve injury,the cortical plasticity of the brain is altered due to damage to and regeneration of peripheral nerves;changes such as neuronal apoptosis and axonal demyelination occur in the spinal cord.The nerve will undergo axonal regeneration,activation of Schwann cells,inflammatory response,and vascular system regeneration at the injury site.Corresponding damage to target organs can occur,including skeletal muscle atrophy and sensory receptor disruption.We then provide a brief review of the research advances in therapeutic approaches to peripheral nerve injury.The main current treatments are conducted passively and include physical factor rehabilitation,pharmacological treatments,cell-based therapies,and physical exercise.However,most treatments only partially address the problem and cannot complete the systematic recovery of the entire central nervous system-peripheral nervous system-target organ pathway.Therefore,we should further explore multilevel treatment options that produce effective,long-lasting results,perhaps requiring a combination of passive(traditional)and active(novel)treatment methods to stimulate rehabilitation at the central-peripheral-target organ levels to achieve better functional recovery.

Which approach of total hip arthroplasty is the best efficacy and least complication?

BACKGROUND Total hip arthroplasty is as an effective intervention to relieve pain and improve hip function.Approaches of the hip have been exhaustively explored about pros and cons.The efficacy and the complications of hip approaches remains inconclusive.This study conducted an umbrella review to systematically appraise previous meta-analysis(MAs)including conventional posterior approach(PA),and minimally invasive surgeries as the lateral approach(LA),direct anterior approach(DAA),2-incisions method,mini-lateral approach and the newest technique direct superior approach(DSA)or supercapsular percutaneouslyassisted total hip(SuperPath).AIM To compare the efficacy and complications of hip approaches that have been published in all MAs and randomized controlled trials(RCTs).METHODS MAs were identified from MEDLINE and Scopus from inception until 2023.RCTs were then updated from the latest MA to September 2023.This study included studies which compared hip approaches and reported at least one outcome such as Harris Hip Score(HHS),dislocation,intra-operative fracture,wound compliData were independently selected,extracted and assessed by two reviewers.Network MA and cluster rank and surface under the cumulative ranking curve(SUCRA)were estimated for treatment efficacy and safety.RESULTS Finally,twenty-eight MAs(40 RCTs),and 13 RCTs were retrieved.In total 47 RCTs were included for reanalysis.The results of corrected covered area showed high degree(13.80%).Among 47 RCTs,most of the studies were low risk of bias in part of random process and outcome reporting,while other domains were medium to high risk of bias.DAA significantly provided higher HHS at three months than PA[pooled unstandardized mean difference(USMD):3.49,95%confidence interval(CI):0.98,6.00 with SUCRA:85.9],followed by DSA/SuperPath(USMD:1.57,95%CI:-1.55,4.69 with SUCRA:57.6).All approaches had indifferent dislocation and intraoperative fracture rates.SUCRA comparing early functional outcome and composite complications(dislocation,intra-operative fracture,wound complication,and nerve injury)found DAA was the best approach followed by DSA/SuperPath.CONCLUSION DSA/SuperPath had better earlier functional outcome than PA,but still could not overcome the result of DAA.This technique might be the other preferred option with acceptable complications.

Chyle leak following root of mesentery dissection in pancreaticoduodenectomy with inferior infracolic superior mesenteric artery first approach

BACKGROUND The root of mesentery dissection is one of the critical maneuvers,especially in borderline resectable pancreatic head cancer.Intra-abdominal chyle leak(CL)including chylous ascites may ensue in up to 10%of patients after pancreatic resections.Globally recognized superior mesenteric artery(SMA)first approaches are invariably performed.The mesenteric dissection through the inferior infracolic approach has been discussed in this study emphasizing its post-operative impact on CL which is the cornerstone of this study.AIM To assess incidence,risk factors,clinical impact of CL following root of mesentery dissection,and the different treatment modalities.METHODS This is a retrospective study incorporating the patients who underwent dissection of the root of mesentery with inferior infracolic SMA first approach pancreat-oduodenectomy for the ventral body and uncinate mass of pancreas in the Department of Gastrointestinal and General Surgery of Kathmandu Medical College and Teaching Hospital from January 1,2021 to February 28,2024.Intraop-erative findings and postoperative outcomes were analyzed.RESULTS In three years,ten patients underwent root of mesentery dissection with inferior infracolic SMA first approach pancreatoduodenectomy.The mean age was 67.6 years with a male-to-female ratio of 4:5.CL was seen in four patients.With virtue of CL,Clavien-Dindo grade Ⅱ or higher morbidity was observed in four patients.Two patients had a hospital stay of more than 20 days with the former having a delayed gastric emptying and the latter with long-term total parenteral nutrition requirement.The mean operative time was 330 minutes.Curative resection was achieved in 100%of the patients.The mean duration of the intensive care unit and hospital stay were 2.55±1.45 days and 15.7±5.32 days,respectively.CONCLUSION Root of mesentery dissection with lymphadenectomy and vascular resection correlated with occurrence of CL.After complete curative resection,these were managed with total parenteral nutrition without adversely impacting outcome.

Slums: The Right for a City? Habitation and Habiting Practices in Slums of Constantine

The human being must find a dwelling and protect himself against the vicissitudes of nature.He has to adapt himself to the contemporary world and to his environment.Sometimes,he should accept unwittingly extreme situations dominated by inhabitability and as such abandon his plot of land and properties and to get into the city where he has to refuge into spaces that any human being enjoying a minimum of living conditions would not accept:the slum.For the time being,he does his best to make his environment enjoyable and to transfer his existence into something of a temporary happiness by trying to make order in these inhospitable places in order to create a sort of happiness that he is the only one who can measure its real impact.Throughout this essay,we are trying to present this human habitation that we often meet in Constantine.

Chemical structures,analytical approaches and toxicological effects of oxidative derivatives of triglycerides as potential hazards in lipid thermal processing:A review

There is an increasing attention on oxidative derivatives of triglycerides,a group of potential thermal processing induced food toxicants,which are formed during the thermal processing of food lipids.This review aims to summarize current knowledge about their formation mechanisms,detection approaches,and toxicology impacts.Oxidative derivatives of triglycerides are generated through the oxidation,cyclization,polymerization,and hydrolysis of triglycerides under high-temperature and abundant oxygen.The analytical techniques,including GC,HPSEC,MS,^(1)H-NMR were discussed in analyzing these components.In addition,their toxic effects on human health,including effects on the liver,intestines,cardiovascular system,immune system,and metabolism were elucidated.Information in this review could be used to improve the understanding of oxidative derivatives of triglycerides and ultimately improve academic and industrial strategies for eliminating these compounds in thermal processing food systems.

Development of a DFN-based probabilistic block theory approach for bench face angle design in open pit mining

In open pit mining,uncontrolled block instabilities have serious social,economic and regulatory consequences,such as casualties,disruption of operation and increased regulation difficulties.For this reason,bench face angle,as one of the controlling parameters associated with block instabilities,should be carefully designed for sustainable mining.This study introduces a discrete fracture network(DFN)-based probabilistic block theory approach for the fast design of the bench face angle.A major advantage is the explicit incorporation of discontinuity size and spatial distribution in the procedure of key blocks testing.The proposed approach was applied to a granite mine in China.First,DFN models were generated from a multi-step modeling procedure to simulate the complex structural characteristics of pit slopes.Then,a modified key blocks searching method was applied to the slope faces modeled,and a cumulative probability of failure was obtained for each sector.Finally,a bench face angle was determined commensurate with an acceptable risk level of stability.The simulation results have shown that the number of hazardous traces exposed on the slope face can be significantly reduced when the suggested bench face angle is adopted,indicating an extremely low risk of uncontrolled block instabilities.

Indication and surgical approach for reconstruction with endoprosthesis in bone-associated soft tissue sarcomas:Appropriate case management is vital

It is important for surgeons performing sarcoma surgery to know that bone resection and tumor prosthesis applications in soft tissue sarcomas(STS)have unique features in terms of indication,surgical approach and follow-up,in terms of the management of these cases.Some STS are associated with bone and major neurovascular structures.Bone-associated STS are generally relatively large and relatively deep-seated.Additionally,the tendency for metastasis is high.In some cases,the decision about which structures to resect is difficult.These cases are often accompanied by poor oncological and surgical outcomes.Management of cases should be done by a multidisciplinary team in advanced centers specialized in this field.The surgical team must have sufficient knowledge and experience in the field of limb-sparing surgery.Preoperative evaluation and especially good planning of bone and soft tissue reconstruction are vital.

Regional Brand and High-quality Development of Fruits in Ethnic Areas of the Yangtze River Economic Belt under the Greater Food Approach

Establishing the Greater Food Approach and promoting the Yangtze River Economic Belt s national major regional development strategy can better support and serve the agricultural power and Chinese-style modernization.This paper introduces the characteristics of fruit industry in 16 autonomous prefectures and 47 autonomous counties under the jurisdiction of the Yangtze River Economic Belt.It studies the intellectual property resources of brand marks from the aspects of geographical indications,collective trademarks,certification trademarks,well-known trademarks in China and national design patents,and analyzes the main problems of brand and high-quality development of fruit industry in these ethnic autonomous areas.Finally,it puts forward some strategies,such as improving the protection of intellectual property rights of geographical indications,using intellectual property rights of brand signs,building modern seed industry upgrading project,drawing lessons from the experience of thousand villages demonstration project,ensuring that large-scale poverty does not occur,and building a diversified food supply system.

Change in the Number of Tropical Cyclone Landfall and Approach over Mozambique from 1980 to 2020

In this study, the variability of tropical cyclone (TC) landfall and approach over Mozambique as well as the environmental factors influencing were investigated. The frequencies of tropical cyclone landfall and approach as well as environmental factors were compared between the two periods (1980 to 1999 and 2000 to 2020). This study found that, according to International Best Track Archive for Climate Stewardship (IBTrACS) tropical cyclone data, the number of tropical cyclones making landfall over Mozambique increased by about 66% in the second period (2000-2020), compared to 34% in the first period (1980-1999). While the number of tropical cyclone approaches reduced from 59% in the first period to 41% in the second period. An assessment of the environmental conditions showed that warmer sea surface temperature (SST) and low vertical wind shear (VWS) were favorable to more TC genesis and, consequently, an increase in landfalls and a reduction in TC confined to the approach.

The Discourse-Historical Approach of Identity Construction in Corporate Promotional Videos for External Publicity Image

Corporate identity construction of external publicity image is an important part of the development of enterprises.Based on Wodak’s discourse-historical approach,this study takes the text of COFCO’s English promotional video as the research object,analyzes the corporate brand image,media image,organizational image,and environmental image constructed by the enterprises from three steps:linguistic expression,discourse strategy,and theme to provide references for Chinese enterprises to enhance their international influence.

Clinical Outcome of Internal Fixation and Fusion in the Treatment of Spinal Fractures by Paraspinal Muscular Space Approach

Objective:To explore the clinical effect of internal fixation and fusion with the paraspinal muscle gap approach in the treatment of spinal fracture patients.Methods:104 spinal fracture patients admitted to Central Hospital of TCM from October 2022 to April 2024 were selected as the study subjects and were randomly divided into the control group(n=52)and the observation group(n=52)according to the random number table method.The control group was treated with the conventional approach of internal fixation surgery,and the observation group was treated with the paraspinal muscular interspace approach of internal fixation fusion.The two groups’general data,surgical indexes,pain,lumbar spine function,and postoperative complications were observed.Results:The baseline data of the two groups of patients were not statistically significant(all P>0.05)while the intraoperative bleeding,the first postoperative time getting up from bed,and the length of hospital stay of the patients in the observation group were shorter than that of the control group(all P=0.000<0.001),and the duration of the operation was longer than that of the control group(t=2.644,P=0.010<0.05);at 3 months postoperatively,the VAS scores of the patients in the observation group were significantly lower than those in the control group(t=10.768,P=0.000<0.001),and the JOA score was higher than that of the control group(t=6.498,P=0.000<0.001);the total complication rate of patients in the observation group(3/5.77%)was significantly lower than that of the control group(12/23.08%)(χ^(2)=6.310,P=0.012<0.05).Conclusion:In the treatment of spinal fracture patients,compared with the conventional approach to internal fixation surgery,the paraspinal muscular gap approach to internal fixation and fusion treatment is less traumatic,postoperative lumbar spine function recovery is faster,and can reduce the incidence of postoperative complications.

Divide and recombine approach for warranty database: estimating the reliability of an automobile component

The continuously updated database of failures and censored data of numerous products has become large, and on some covariates, information regarding the failure times is missing in the database. As the dataset is large and has missing information, the analysis tasks become complicated and a long time is required to execute the programming codes. In such situations, the divide and recombine (D&R) approach, which has a practical computational performance for big data analysis, can be applied. In this study, the D&R approach was applied to analyze the real field data of an automobile component with incomplete information on covariates using the Weibull regression model. Model parameters were estimated using the expectation maximization algorithm. The results of the data analysis and simulation demonstrated that the D&R approach is applicable for analyzing such datasets. Further, the percentiles and reliability functions of the distribution under different covariate conditions were estimated to evaluate the component performance of these covariates. The findings of this study have managerial implications regarding design decisions, safety, and reliability of automobile components.

Application of Maximum Probability Approach to the Fault Diagnosis of a Servo System

In an actual control system, it is often difficult to find out where the faults are if only based on the outside fault phenomena, acquired frequently from a fault system. So the fault diagnosis by outside fault phenomena is considered. Based on the theory of fuzzy recognition and fault diagnosis, this method only depends on experience and statistical data to set up fuzzy query relationship between the outside phenomena (fault characters) and the fault sources (fault patterns). From this relationship the most probable fault sources can be obtained, to attain the goal of quick diagnosis. Based on the above approach, the standard fuzzy relationship matrix is stored in the computer as a system database. And experiment data are given to show the fault diagnosis results. The important parameters can be on line sampled and analyzed, and when faults occur, faults can be found, the alarm is given and the controller output is regulated.

Incorporating the Reflective Approach into Teacher Professional Development

There exists an increasing tendency in the ELT field that the teaching is referred as a profession. In our context, being professional means being the effective teacher, which is required to develop continuously throughout the whole career. Teacher professional development, in this article, mainly the issue of teacher professional self-development is discussed. In order for that to be realized, the reflective approach is bring introduced. Here, the reflective approach is primarily based on doing Action Research that includes Rettospective technique, Observation technique, Questionnaires and Interviews and Case Study.

Approaches for Improvement of Competitiveness of Bama Rural Health-caring Tourism from the Deep Perspective of Tourism,China

After analysis of characteristics of Bama rural health-caring tourism,it had highlighted monopolisticness of longevity culture,diversity of tourist resources,and harmony between human and nature.The paper pointed out that,to accelerate new countryside construction of Bama rural health-caring tourism,it should realize nearby employment and increase farmers' income;complete construction of rural basic facilities;ameliorate rural sanitary condition and transform villagers' thought;promote adjustment of rural industrial structure;and establish protection mechanism of longevous people.After survey on development of Bama rural tourism,it concluded bottlenecks restricting Bama rural tourism development,which were that environment at longevity area had suffered pollution;that the development was disordered and lacked of management;and that basic facilities waited for improvement.On this basis,approaches for improvement of competitiveness of Bama health-caring tourism had been proposed.It emphasized that it should enhance protection of longevity tourist resources,build farmhouse inn demonstration base,implement admittance system,establish community health-care system,beneficial to realizing economic,social and ecological benefits,and further manifesting its exuberant vitality.

A Genre-Based Approach to the Teaching of Writing

The essay explains why the writing skill is often perceived to be the most difficult language skill to master; to what extent can a genre approach to teaching writing help students master the skill of writing compare briefly to other skills such as product approach and process approach; and introduce a new approach process-genre approach.

Analysis on the Application of Genre-based Approach to English Teaching

The awareness of applying genre in teaching and learning language has been aroused recently, and the choices of genres are connected closely with teachers' teaching goals and the needs of students. This paper which holds certain pedagogic purpose, analyzes genre-based teaching approach via an analysis on an English text book named Changes (level 1), aiming to help EFL teachers cultivate their genre awareness.

Employing the Communicative Approach to Improve the Competence of Listening and Speaking

It is well know that a human linguistic communicative behavior,listening and speaking occupies a very important position in both our daily life and foreign language teaching.Now the classroom becomes more student-centered with the teacher allowing for students to output the language more often on their own.In order to improve the students' listening and speaking,the Communicative Approach has been exploited,which is based on communicative efficiency.It sees communicative competence of language.